Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Ninety-five consecutive patients underwent PLIF with CBT screw fixation for DS (CBT group; mean followup 35 months). A historical control group consisted of 82 consecutive patients who underwent PLIF with traditional PS fixation (PS group; mean follow-up 40 months). Clinical status was assessed using the Japanese Orthopaedic Association (JOA) scale score. Fusion status was assessed by dynamic plain radiographs and CT. The need for additional surgery and surgery-related complications was also evaluated.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The mean JOA score improved significantly from 13.7 points before surgery to 23.3 points at the latest follow-up in the CBT group (mean recovery rate 64.4%), compared with 14.4 points preoperatively to 22.7 points at final follow-up in the PS group (mean recovery rate 55.8%; p &lt; 0.05). Solid spinal fusion was achieved in 84 patients from the CBT group (88.4%) and in 79 patients from the PS group (96.3%, p &gt; 0.05). Symptomatic adjacent-segment disease developed in 3 patients from the CBT group (3.2%) compared with 9 patients from the PS group (11.0%, p &lt; 0.05).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>PLIF with CBT screw fixation for DS provided comparable improvement of clinical symptoms with PLIF using traditional PS fixation. However, the successful fusion rate tended to be lower in the CBT group than in the PS group, although the difference was not statistically significant between the 2 groups.</jats:p></jats:sec>

Feasibility and safety of using thoracic and lumbar cortical bone trajectory pedicle screws in spinal constructs in children: technical note

“…In clinical practice, adults with degenerative lumbar spondylolisthesis treated with cortical bone trajectory pedicle screws or conventional trajectory pedicle screws attained statistically equivalent patient-reported outcomes and fusion rates. 18 Insertional torque was found to be almost twice as high for the cortical bone trajectory pedicle screws than for traditional trajectory pedicle screws. 13 In another study 23 of 79 adults with degenerative lumbosacral disease, the authors demonstrated that the use of cortical bone trajectory pedicle screws was associated with acceptable operative outcomes with a low complication rate.…”

Robot assisted midline lumbar fusion with cortical bone trajectory screw

“…Mori et al showed that mean post-operative and latest follow-up JOA scores were significantly increased from mean pre-operative scores in patients who underwent CBT [15]. Sakaura et al investigated JOA scores in patients who underwent CBT, pre-operative and post-operative JOA scores were significantly improved when compared [16]. In both our group, we have get the same result in the final follow-up.…”

The safety and effectiveness of MIDLF during one surgeon’s initial phase: accuracy, clinical outcome, complications and learning curve

“…The superior pullout strength, higher insertional torque and satisfactory stability of the screw-rod construction compared to the traditional fixation have been confirmed by biomechanical studies [7,10,[12][13][14][15][16][17][18]. And the comparable clinical outcomes, less multifidus muscle damage and less complications associated with instrumentations compared to PS have been observed in clinical studies [19][20][21][22][23][24]. However, the CBT screws placement accuracy, surgical parameters and complications in one surgeon's learning curve could rarely be found in literature.…”